The overall goal of this proposal is the establishment the Centro Latino Americano de investigacion en Malaria - CLAIM as a non-Amazonian malaria research center that would generate knowledge and provide technical and scientific support to governments of the partner countries as well as to organizations and health care institutions to further contribute to malaria elimination programs in the regions. CLAIM would initially bring together field sites from Colombia, Peru, Panama and Guatemala, and has plans to further include sites from Ecuador and Honduras and possibly other endemic countries of the Latin American (LA) and the Caribbean such as Haiti. CLAIM will be composed of multiple public and private research centers from the original partner countries, including centers and organizations depending from or associated to the Ministries of Health (MOH) from all participant countries. CLAIM has also involved consultants/collaborators from the Andean Health Organism and/or the US Centers for Disease Control for this ICEMR program. In addition, to the scientists from the partner countries, CLAIM will have the participation of prominent and experienced scientists from other endemic countries such as Ecuador and Brazil, as well as from United State (USA) and Europe. The ICEMR research activities have been divided into three closely inter-related projects as follows: Project 1 on Epidemiology will determine the ecological and epidemiological features in non-Amazonian regions; Project 2 on malaria transmission will address major gaps in our understanding of the ecology, behavior, vector potential, and control of Anopheles malaria vectors to guide the development and implementation of more effective integrated Vector Management (IVM) strategies, and Project 3 on malaria pathogenesis, that it will determine the clinical outcome of malaria infections and its correlation with the immunological status in communities living under different intensifies of malaria transmission in the study region. CLAIM would involve its epidemiology team to closely work with the National Malaria Control Program (NMCP) of all partner countries, to locate and track the hot spots and to assess the changing epidemiological conditions, identifying the malaria patterns and establishing linkages with environmental and anthropogenic factors or other determinants of malaria transmission. The study team will provide technical assistance for helping NMCPs improve surveillance operations, including quality control and assurance of data with respect to diagnostics. This ICEMR proposal includes training activities for selected junior scientists and groups of researchers/technicians. Special projects will be initiated by Year 3 of the program and will profit to redirect the program and/or involve other countries. A Data Management (DM) Core will coordinate all research protocol, DM, data analyses and publications. All CLAIM activities will be coordinated by Core A under responsibility of Caucaseco SRC. CLAIM will combine the multidisciplinary and integrated approach to enhance the research underpinnings for effective malaria elimination and possibly eradication. Data and findings generated by this Center are expected to provide input critical to inform future research design and evaluation of new interventions and control strategies. RELEVANCE: This is a comprehensive project designed to establish an international Center of Excellence for Malaria Research in Latin America (CLAIM) composed of multiple public and private research centers from the endemic countries, the USA and Europe working jointly to find alternatives for malaria control. Results will facilitate malaria elimination in low malaria endemic settings. PROJECT 1: Title: Epidemiology of Malaria Transmission in Low to Moderate Settings of Latin America Project Leader: Herrera, S. PROJECT 1 DESCRIPTION (provided by applicant): The main objective of Project 1 is to evaluate the diversity of the ecology and parasite populations related to the epidemiology and clinical findings in order to establish a scientific framework that supports the development of new intervention strategies for malaria elimination in non-Amazonian areas of LA. This goal will be approached through the following specific aims: 1) Study the epidemiology of seasonal malaria and their relationship with parasite population diversity and 2) Identification of risk factors associated with malaria transmission in non-Amazonian areas of LA countries. We hypothesize that circulating Plasmodium populations and their dynamics modulate the clinical manifestations and immune responses in the affected populations and that vector bionomics, parasite population diversity, host biology and behavior, household conditions, and local environmental conditions, act simultaneously to determine malaria transmission and risk of infection. The studies proposed for aim 1 are directed to determine the real prevalence and incidence of malaria by considering both symptomatic and asymptomatic individuals living in seasonal areas in LA. This investigation includes community based cohort studies (prospective studies), active surveillance using temporal cross-sectional studies, and hospital based passive surveillance studies. The studies will be carried out in 7 endemic areas of Colombia, Peru, Panama and Guatemala, where a total of 21 sentinel sites will be studied. Studies will be carried out in three phases: 1) Our own census of the selected population from sentinel sites where inhabitants will be registered using a demographic questionnaire and houses coordinates using a GPS system; 2) thick smear and PCR for malaria diagnose in selected sentinels sites and random sampling in order to determine asymptomatic gametocytes carriers; 3) clinical follow-up and thick smear of asymptomatic at two sentinel sites (one in Colombia (Tierralta) and one in Peru (Sulluna). For aim 2 we will a) assess the conditions of antimalarial use in communities where malaria is endemic, including adherence, self-medication and prophylaxis; and (b) study the conditions of use of antimalarials in the public and private health institutions including the availability and suitability to care guides. In this ICEMR program, we will establish a network of sentinel sites that will be selected integrating bio-geographic criteria (vector and ecological conditions) and epidemiological information. Sentinel sites will provide baseline information on malaria ecology and epidemiology with the goal of characterizing parasite and vector populations resilient to control interventions. Such network will allow supporting current efforts directed to develop population models to quantify disease dynamics and malaria risk-maps to support MOH elimination activities. RELEVANCE: Identify the relationship between environmental factors, parasite characteristics, household conditions and the malaria prevalence related to the epidemiology and clinical findings.